If the gastric mucosa is damaged, this can lead to a gastric rupture or gastric perforation. An open gastric perforation almost always represents a medical emergency.
What is gastric perforation?
In the context of a gastric perforation (also known as gastric perforation in medicine ), the stomach wall of an affected person breaks.
According to Lawfaqs, a distinction can be made between open and covered gastric perforation; if there is an open gastric perforation, there is a risk, among other things, that the contents of the stomach will spill into the abdominal cavity. An open gastric perforation usually requires immediate, emergency medical intervention. A closed gastric perforation is characterized by adhesions in the stomach that come into contact with neighboring organs.
In most cases, an open gastric perforation is associated with significantly more severe symptoms than a closed perforation; The most common symptoms of an open stomach perforation include severe and stabbing pain in the upper abdomen, which in some cases can also radiate to the shoulders.
Perforation in the stomach is usually caused by gastric ulcers in those affected: gastric ulcers lead to damage to the gastric mucosa, which protects the stomach wall from gastric acid in healthy people. If this protection is lost, the stomach wall can be attacked at appropriate points; a severe consequence is gastric perforation.
Other causes that can be hidden behind a gastric perforation include, for example, injuries in the course of gastroscopy. Accidental ingestion of corrosive substances can also result in gastric perforation. Furthermore, gastric perforation can be caused by long-term use of medication; various drugs have a tendency to attack the lining of the stomach, increasing the risk of gastric perforation.
Drugs that can have a corresponding effect include cortisone (an active component that is used, for example, as an anti- inflammatory ). In very rare cases, a gastric perforation can also be the result of cancer affecting the stomach.
Symptoms, Ailments & Signs
An open gastric perforation is typically expressed by severe, stabbing pain in the middle of the upper abdomen. The pain can radiate to the chest and shoulders. The symptoms usually appear very suddenly – in some cases, however, they are preceded by a longer medical history. If stomach contents get into the abdominal cavity, there is a risk of peritonitis.
The pain spreads in the abdomen, resulting in a relieving posture. Also characteristic is the hardening of the abdominal wall, accompanied by severe pressure pain and an increasing feeling of illness. With a covered perforation, the symptoms are less pronounced.
Usually slight pain is noticed, which increases in intensity over the course of several days. An open gastric perforation does not go away on its own. This is a medical emergency that requires medical attention. Otherwise, the symptoms will increase and there is an acute threat to the patient’s life.
If left untreated, a covered gastric perforation also takes a severe course, with increasing pain and a growing feeling of illness, which significantly affects well-being. With early treatment, the symptoms disappear after a few days. The feeling of illness may last for one to two weeks, depending on the severity of the perforation.
Diagnosis & History
The suspected diagnosis of gastric perforation is initially possible for a physician because of the typical, stabbing pain of a patient; As a rule, information regarding the individual medical history and initial symptoms also flow into a corresponding suspected diagnosis. The suspicion of a gastric perforation can be checked in a next step using an X-ray; If free air can be seen in the abdominal cavity, this speaks for an existing gastric perforation.
While a closed gastric perforation is often comparatively mild and has good chances of recovery, various complications can occur in the context of an open gastric perforation: For example, if the contents of the stomach penetrate into the abdominal cavity, it can cause life-threatening peritonitis; A corresponding inflammation is often associated with widespread abdominal pain and a hardened abdominal wall.
Life-threatening complications can occur as a result of gastric perforation. In addition to the severe pain, a perforation can cause peritonitis, which can lead to fever, constipation and possibly even an intestinal blockage. Rarely, septic shock with fluctuations in blood pressure, respiratory disorders and circulatory failure can occur. In severe cases, peritonitis leads to death.
Another possible complication is blood poisoning. Also associated with pain and fever symptoms, sepsis can lead to multiple organ failure and even impair nerve and brain function. If the brain is affected, there can be permanent limitations in memory and learning. If the nervous system is affected, symptoms of paralysis and chronic pain can occur.
A covered perforation, such as occurs with adhesions, can lead to fistula formation with neighboring organs. As a result, severe organ damage can occur. If the gastric perforation is treated in time, there are usually no further complications.
Sometimes, however, the person affected has to change their diet. In addition, the prescribed drugs can cause side effects and allergic reactions. In order to avoid complications, a doctor should be consulted immediately if gastric perforation is suspected.
When should you go to the doctor?
Sudden pain in the upper abdomen, pain when touched or a hardening of the abdominal wall are signs of health problems. A doctor’s visit is necessary so that the cause of the symptoms can be determined. A gastric perforation is a medical emergency that needs to be treated as soon as possible. Therefore, if the symptoms that occur rapidly increase in intensity in a short period of time, an emergency medical service is required. Until he arrives, the people present are to provide first aid measures to ensure the survival of the person concerned.
A doctor is needed if the feeling of illness increases, if there is a general feeling of being unwell and if there is inner weakness. If cramps, bleeding, vomiting or nausea occur, consult a doctor. If you have a fever, heart rhythm disorders, loss of appetite or problems with the digestive tract, you should see a doctor for a check-up. If the affected person adopts a relieving posture, if the need for sleep increases and if he suffers from fatigue and exhaustion, a doctor should be consulted.
If the usual level of performance drops, if professional or everyday obligations can no longer be fulfilled or if sleep disorders set in, a doctor’s visit is necessary. A loss of well-being, increased body temperature and inner restlessness are signs of an irregularity. If the symptoms persist for several days or if they gradually increase in intensity, a doctor is needed.
Treatment & Therapy
The medical treatment of a gastric perforation depends, among other things, on the form of the existing perforation and individually occurring complications as part of the course of the disease.
If an open gastric perforation requires emergency medical care, surgical intervention is unavoidable in most cases; In the course of an operation, the perforation in the stomach wall is usually closed first. Subsequent flushing of the abdomen frees the latter of stomach contents that were able to empty out of the stomach in the course of the gastric perforation – such flushing after an open stomach perforation helps to reduce the risk of peritonitis or the progression of an inflammation that has already occurred to prevent.
The surgical interventions necessary in the case of an open gastric perforation are usually carried out under general anesthesia and are minimally invasive (the abdominal wall does not have to be opened extensively with an incision). If someone affected by an open gastric perforation has severe peritonitis, this is often observed in intensive care medicine. A covered gastric perforation does not require surgical intervention in many cases; occasionally the stomach is relieved here by a gastric tube.
Outlook & Forecast
An open gastric perforation is life-threatening. If there is no timely treatment in the form of an operation, the patient is at risk of death. Early intervention is always preferable. 24 hours after the breakthrough, the probability of survival is only 50 percent. With every additional hour of waiting, it decreases. The general condition and age of the patient are also relevant for healing. Certain pre-existing conditions can reduce the likelihood of recovery.
If the contents of the stomach get into the abdominal cavity, the chances of recovery deteriorate considerably. Inflammation can occur. A significantly better prognosis results from a covered gastric perforation. There are only connections to other organs. The doctor decides on the therapy based on an X-ray image. Surgical intervention is not always necessary. Conservative therapies sometimes promise a cure as well. A covered gastric perforation is usually not a life-threatening situation.
Successful acute treatment does not automatically lead to a full recovery. Some patients can no longer consume all the foods they are used to, which results in minor to major limitations in everyday life. It is not possible to predict to what extent there is an intolerance after gastric surgery.
Since gastric perforation is caused by gastric ulcers in most cases, early treatment of such ulcers can prevent perforation of the stomach wall. If, in an individual case, long-term use of medication has already led to stomach damage, medical advice on alternative preparations can help to prevent gastric perforation.
Follow-up care for gastric perforation depends on the severity of the disease. In milder cases, regular examinations are sufficient to clarify whether the healing process is proceeding as expected. Physical exertion should be avoided, sometimes those affected are dependent on the help of family and friends in everyday life. The usual routine should be taken up slowly, in order to protect the ailing stomach, a change in diet with light, low-acid food is recommended.
Every patient should also discuss with their doctor what should be considered when changing their diet. In addition, symptoms such as frequent heartburn, stabbing stomach pains or vomiting blood must be linked to the previous history and clarified in the future. In more severe cases, tightly scheduled checks are required in order to avert further complications in good time.
You can do that yourself
People with a perforated stomach experience a medical emergency. Those affected behave correctly if they immediately call an emergency doctor or observers of what is happening take over this activity. A gastric rupture is a sudden physical collapse. In some patients, this acute condition has been apparent for a long time due to various symptoms. Therefore, to avoid gastric perforation, a doctor should be consulted in good time.
If an emergency occurs, first aid is necessary for the organ failure so that the patient does not die prematurely. Avoid excitement, well-intentioned advice, and debate as much as possible. The person concerned should refrain from unnecessary movements until the emergency doctor arrives and try to remain calm despite the severe pain. Regular breathing is necessary so that the organism is supplied with sufficient oxygen.
If unconsciousness occurs, bystanders are obliged to check that breathing is ensured. If it fails, artificial respiration must be initiated using the mouth-to-mouth technique. Due to the symptoms, the patient automatically adopts a relieving posture. This is a natural human reaction that ensures survival. Immediate surgical intervention is necessary to prevent further diseases or inflammation. There are no alternative options in the event of a gastric perforation.